非造血组织肿瘤骨髓转移的诊断及肿瘤细胞形态学特点.pdfVIP

J South Med Univ, 2014, 34(10): 1541-1545 doi 10.3969/j.issn.1673-4254.2014.10.29 . 1541 • 临床研究 非造血组织肿瘤骨髓转移的诊断及肿瘤细胞形态学特点 李莉，丛玉隆，蔡力力，邓新立，关杰 解放军总医院南楼检验科，北京 100853 摘要:目的分析骨髓转移性肿瘤的临床表现及血液学特征，观察骨髓转移性肿瘤细胞形态学特点，提高对该疾病的诊断。方法 选择我院2009-2014年所有经骨髓细胞学检查确诊的77例骨髓转移性肿瘤患者，对其临床特征及实验室检查(血常规、血生化、 肿瘤标志物、血象及骨髓象)进行回顾性分析。结果50岁以上的中老年患者占64.9%0 I临床上以骨痛(65%) 、贫血伴血小板减 少(63.6%)及幼红幼粒细胞血症(61%)最常见。血液学指标发现血沉(ESR) ，血清碱性磷酸酶(ALP) ，L酸脱氢酶(LDH)、癌胚 抗原(CEA)升高明显，血清白蛋白(AL8)减低。骨髓细胞学检查发现不同原发病灶的骨髓转移癌形态特点不同，共性特点是涂 片尾部及边缘可见数量不等的散在或成团、成簇分布的癌细胞，合胞体及退化癌细胞。结论依据骨髓细胞学检查判断肿瘤 原发灶较为困难，但对神经母细胞瘤、小细胞肺癌、胃癌(印戒细胞癌)的诊断具有参考意义。骨髓转移性肿瘤的诊断要注重癌 症病史症状体征实验室检查的综合分析。 关键词:肿瘤;骨髓转移;诊断;细胞形态学 Clinical and cytomorphological features of bone marrow metastasis of non-hematological malignant carcinoma LI Li, CONG Yulong, CAI Lili, DENG Xinli , GUAN Jie Department of Clinical Laboratory in South Building, General Hospital ofPLA, Be扩ing 100853, China Abstract Objective TO analyze 也e clinical manifestatiOns and hematOlOgic p缸皿\eters and Observe the cytOmorpholOgical features Of metastatic tumOrs in the bone marrOw Origina出.g from different prim町Y si阳.Me血。ds The clinical data Of 77 patients with bOne m町Ow metasta tumOrs admitted between 2α)9 and 2014 betw由贸\2α)9 and 2014 in G回回al HOspital Of PLA were studied 陀忧凶pectively to analyze 耻indicatiOns Of laboratory examinatiOns (hematOlogicallaboratOry t臼旬:， tumOr markers, peripheral blood films, and bOne m缸rOwaspirat凶). Results of 由.e 77 patients analyzed, 64.9% were Over50 ye缸s Of a.ge. The mOst cOmmOn cliniα1 characteristics were bone pain (65%), anemia wi也出rOmbocytOpenia (臼.6%) and leuk回可由oblastic reactiOn (61%).τbe hematOlOgical abnOrmalities included elevatiOn Of ESR, ALp, LDH, tumOr markers, and hypOproteinemia. CytOlOgical ex缸时natiOn Of bOne marrOw aspiration samples revealed different mOrphOlOgical characteristics Of the metastatic ælls 仕om di丘erent primary sites; in